Dear Council on Graduate Medical Education, I am writing to you today on behalf of a group of 227 unmatched physicians. This group is speaking up for the interests of the 6,570 doctors that went unmatched this year through the national residency matching program (NRMP) and the AAMC sponsored electronic residency application service (ERAS). Every year this number has grown for the past ten years despite a slow increase in residency programs. The issue appears to be cut and dry. There are more applicants then there are positions but if you look deeper you will find some very counter intuitive practices occurring. For instance, a fourth of residency positions are taken by visa holders while U.S. citizen doctors in the thousands are left jobless. Visa programs were created to boost skilled labor coming to the U.S. and one application is for training of doctors. They are short sighted however; they have produced far more applicants for U.S. residency spots than there are residency spots available. If as a country, we are choosing to import doctors instead of training our own citizens then we should state that and inform our citizens before they enter into training. It makes no sense to provide federal loans to students to get a medical education but leave the ultimate job unfunded. As a result, each person in my group has received a scarlet letter letting us know we are not desirable due to a number of factors. We get labeled with these factors through our rejection letters and personal conversations with program directors.
I am writing today in the hopes of changing the narrative. Let me tell you what each person in my group has in common. We are educated leaders who are able and willing to contribute to the betterment of the healthcare of America. We do have the right to work and be productive members of society in the profession that we have chosen as U.S. Citizens. We are medical graduates. We have passed our medical licensing exams. We qualify for NRMP and ERAS and if we were selected into a residency spot there would not be any regulatory issue preventing us from that training.
Year after year we lose hope that the livelihood we have dedicated our lives to is just a hair out of our reach due to forces outside of our control. Thus, I would contentiously contend against the stereotype that comes to mind when you think of an unmatched MD. I ask that you oppose this stereotype and please take a few seconds to see things from our side by observing the adversity we have overcome to even be writing you this letter. In order for this wrong to be righted, we need our voices to be heard and actions to be taken on our behalf by those in government. COGME, please empathize with us and help us by making recommendations to congress that address our plight. At the end of this letter there is a summary of potential solutions that could fix this problem quickly.
Background of the problem:
The primary qualifications for US residency are passing of USMLE (United States Medical Licensure Program) steps 1 and 2 and having graduated from a duly accredited medical school. The National Residency Matching Program (NRMP) was conceived not as a qualification measure or process but strictly as a matching process. Yet every year the NRMP, albeit inadvertently, essentially and inappropriately, with respect to it’s professed mandate, disqualifies and locks out many qualified medical graduates from residency training. US residency is a critical capstone phase in the training of American physicians and under current medical regulations must be completed in order for US citizen MD graduates to capitalize on their 8 year plus of education beyond high school i.e. be license- eligible to practice medicine.
[It must here be pointed out that no other profession in the USA is that way: not engineering, not law, not nursing, not physician assisting. In fact most state-proposed “assistant physician” legislation which recognizes this issue and would provide an avenue of practice for MD graduates without residency, is being largely rejected by medical leaders] Without residency it is as though those 8 plus years of study were for nothing. Contrary to popular intuition and perception, medical graduates without residency training are not seen by employers as a good fit for other occupations and even more troubling, they are seen as “over qualified” by occupations with much overlap such as medical research. One cannot thoroughly examine this problem without emphasizing that medical training in the United States, unlike in almost every other developed society, follows an abridged model with pre-residency education and training on one hand, and licensing-independent-practice training on the other hand.
The NRMP process is the critical bridge. All pre-residency qualifications are rendered useless to the professional world without candidates crossing this bridge. The USA is the only nation where MD graduates risk being “stranded” on this bridge with no where to go after graduation if they don’t get a residency: it is like a bridge that ends in a limbo and if you are not selected you do not have an avenue of escape from it. In every other country MD graduates are license/practice-eligible, or at least professional-progression-eligible in their country of education. The match process by the NRMP without built -in protection for access to residency by qualified American graduates (we must reiterate all unmatched applicants are in fact residency-qualified as matter of course) has created a situation where unmatched American graduates are at a perilous disadvantage compared to applicants from other countries. Essentially if these foreign applicants don’t match in the USA they can still practice in their own country and earn a living. Not so with American graduates. The limbo of not matching is like being trapped: unqualified or over qualified for every other comparable job while being saddled with $200,000 to $500,000 in federal student loan debt, not to mention the absolute waste of highly trained American minds and the massive loss to the American patient population in healthcare services that would otherwise be readily available.
The recent bill, S348 Physician Shortage Reduction Act of 2019, would add residency spots every year which would help by creating new residency positions. It would be ideal for this bill to address the needs of past U.S. citizen medical graduates and facilitate our placement into the first few spots of the new programs.
A second option could be rather than giving out visas for residencies right away, we could instead provide residency positions to all U.S. citizen M.D.’s first and leave the remaining positions for VISA holders. This could be incorporated directly into NRMP or ERAS through the addition of a U.S. citizen filter. We would also ask that filters for ERAS applications be looked at. We would like year of graduation and attempts on step exams be removed to allow our applications to be seen, instead of being automatically being removed from the applicant pool. We would also ask for program’s that only take VISA doctors to be audited. We fear that VISA doctors are being taken preferentially over U.S. citizen doctors with similar test scores.
A third option could be the creation of a federal assistant physician position within the V.A. or other healthcare arm. This would be where the unmatched M.D. works under the supervision of another M.D. while fulfilling prerequisites for a path to residency or licensure. Legislation pertaining to this issue can be seen in the state of Missouri where unmatched physicians can fill into these assistant physician roles. A final recommendation would be the creation of new rural programs that allow residents from a particular community to receive higher consideration in the match for residency positions within that community due to the high likelihood that the resident will stay and aid in that community after their training has completed. I say this because our group would be more than happy to practice family medicine rurally. Again, we must also request that spots within these new programs be made available to U.S. citizen M.D.’s that have gone unmatched in previous years first. It is important that we right this wrong and get U.S. citizen M.D.’s that are currently unemployed working again.
We would be willing to help in any way possible! For instance, as I mentioned, we could help in rural healthcare underserved areas. We would be willing to go into homes to meet with our patients as mentioned in your 19th COGME report, become telehealth providers as mentioned in April 2020 minutes, or practice rurally as mentioned in the July 2020 issue brief. This country is in need of doctors, having one of the lowest population: doctor ratios in the world, and we aim to help. Rather than importing this workforce, we implore you to let us help!
We ask COGME to help stop U.S. citizen doctors from going unmatched by advocating for us within congress and other governmental bodies. Again, there are thousands of U.S. citizen physicians that could aid in our current healthcare crisis by fitting into a variety of roles within the healthcare system. We are an extremely thoughtful and gracious bunch who after years of disappointment and heartbreak are still willing to put all grievances aside to fulfill our dream of practicing medicine. Our stories of hardship will not end until a place is made for us within the current system.
Thank you for your time,
Unmatched and Unemployed Doctors of America
We have been tweeting videos of our stories and have recently started a blog with our stories. This blog already has 16,000 views in under a week and our twitter videos have received over 50,000 combined views. We would like your council, congress and President Trump to see our stories and help us right this wrong (https://white-collar-workers-ofamerica.org/2020/09/03/unmatched-american-doctors-blog) . We are sponsored by Amworkco, NumbersUSA, White Collar Workers of America, and Doctors Without Jobs.
Rural GME is recommending the increase of Visa Doctors at their July 2020 meeting, this is totally unacceptable when we are over 6570 Americans who are ready, qualified and exam certified for Family medicine residency training. https://www.hrsa.gov/sites/default/files/hrsa/advisory-committees/graduate-medical-edu/meetings/20200717/rural-residency-development.pdf
July 2020 meeting!!